Ureteroscopic Kidney Stone Removal

WHAT YOU SHOULD KNOW:

Ureteroscopic Kidney Stone Removal (Inpatient Care) Care Guide

Ureteroscopy (u-re-ter-OS-kah-pee) is a procedure done to remove kidney stones. Kidney stones are also called renal calculi. Kidney stones are rock-like pieces that can form anywhere in the urinary system. This includes the kidneys, bladder, ureters and urethra (urine tubes). Your kidneys clean waste from the blood and make urine. The stone may be large or small. You may have more than one stone. Ureteroscopy is used when the stone is in the middle or lower part of the ureter. The ureters are the tubes that go from your kidney to your bladder where urine is stored, before it is passed out of your body. Ask caregivers for more information about kidney stones and ways to treat them.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

There are risks with kidney stone removal. You may bleed more than usual or get an infection. You could have trouble breathing or get blood clots. You may need surgery or another procedure if the stone was not broken small enough to pass in your urine. Kidney stones can cause a kidney infection and can stop urine from moving out of your kidney. If a kidney stone causes these problems and you do not get it fixed, your kidneys could stop working. This could cause you to die. Your ureter could be torn or damaged during this procedure. Your ureter may grow scar tissue after the procedure and block the flow of urine.

WHILE YOU ARE HERE:

Before your procedure:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • KUB x-ray: You may need a KUB x-ray before your procedure. An x-ray machine is used to take pictures of your kidneys, ureters, and bladder. Your caregivers look at these pictures to see where the kidney stone is located before your procedure.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • Pre-Op care: You may be given medicine in your IV to make you feel sleepy and more relaxed. You will be taken on a cart to the room where your procedure will be done. Your caregiver will help you get comfortable on the bed. If you get cold, ask for more blankets.

  • Anesthesia: This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your caregiver if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.

    • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

    • Local or monitored anesthesia: Anesthesia is medicine that keeps you from feeling pain during surgery or a procedure. Local anesthesia is a shot of numbing medicine put into the skin where you will have surgery. You will be fully awake during the surgery or procedure. You may feel pressure or pushing, but you will not feel pain. Monitored anesthesia means you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the surgery or procedure.

    • Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.

During the procedure:

  • You will lie on your back with a sheet covering you during the procedure. Caregivers help you bend your knees and put your feet and legs into stirrups or leg holders. Your groin and urethra (tube that drains urine from the bladder) are cleaned with soap. The soap may make your skin yellow, but will be cleaned off later.

  • A ureteroscope is put through your urethra and bladder into your ureter. The ureteroscope is a long thin tube with a light and magnifying glass on the end. Your doctor will put instruments like tiny forceps through the scope to grab small stones. Larger ones are shattered (broken into tiny sand-like pieces) using a machine such as a drill, ultrasound, or laser. These tiny pieces of stone will be passed in your urine in the next few days.

  • Ureteral stent: This is a small bendable tube that is placed inside your ureter. A stent may help the broken pieces of stone pass and help the lining of the ureter heal.

After the procedure:

You will be taken to the recovery room. You will stay there until you wake up. You will then be taken back to your room or will be allowed to go home. Do not get out of bed until your caregiver says it is OK.

  • Activity: Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy, sit or lie down right away. Then call your caregiver.

  • Prevent constipation: High-fiber foods, extra liquids, and regular exercise can help you prevent constipation. Examples of high-fiber foods are fruit and bran. Prune juice and water are good liquids to drink. Regular exercise helps your digestive system work. You may also be told to take over-the-counter fiber and stool softener medicines. Take these items as directed.

  • Deep breathing and coughing: This will help decrease your risk for a lung infection after surgery.

    • Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.

    • You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Drinking liquids: Follow your caregiver's advice about how much liquid you should drink. For most people, good liquids to drink are water, juices, and milk. Limit the amount of caffeine you drink. Caffeine may be found in coffee, tea, soda, and sports foods and drinks. It is very important to drink fluids after kidney stone removal. This helps clean out any remaining small pieces of stone. Drink liquids in the evening to be sure that you will make urine through the night.

  • Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Caregivers often call this "I&O".

    • Ask your caregiver how much liquid you should be drinking. Write down how much you are drinking, and tell your caregiver.

    • Caregivers may need to strain your urine to check for stones. Do not flush your urine down the toilet unless caregivers say it is OK.
      Look for Stones in the Filter

  • Medicines:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

      • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

    • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

  • Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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